Healthcare Provider Details

I. General information

NPI: 1407385180
Provider Name (Legal Business Name): LUBIN JUAREZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 08/10/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEDICAL CAMPUS DR STE 300
LANSDALE PA
19446-7205
US

IV. Provider business mailing address

125 MEDICAL CAMPUS DR STE 300
LANSDALE PA
19446-7205
US

V. Phone/Fax

Practice location:
  • Phone: 215-362-7125
  • Fax: 215-362-7175
Mailing address:
  • Phone: 215-362-7125
  • Fax: 215-362-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03970
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD478088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: